(PDF 110 KB—Includes ONLINE EXTRA: Diagnosis Codes for CPT Code 92132)
The latest edition of the AMA’s Current Procedural Terminology saw the addition of a new Level I code, 92132, for anterior segment OCT. Here’s a quick guide to using it.
Payment is bilateral. This means payment is made once, whether one or both eyes are tested. It is therefore inappropriate to bill with modifier –50 or eye modifiers –RT and –LT. The typical Medicare allowable is $42.
CCI edits apply to 92133 and 92134. Correct Coding Initiative edits state that code 92132 can’t be billed the same day as either 92133 Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve or 92134 Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina.
The physician does not need to be available. Supervision rules do not apply to code 92132.
There are exceptions to its experimental/ investigational status. It is still seen as experimental/investigational, which means your claims may be denied, except in these cases:
- Evaluating narrow angle–, suspected narrow angle–, and mixed narrow- and open-angle glaucoma.
- Evaluating iris tumor.
- Determining the proper intraocular lens for a patient who has had prior refractive surgery and now requires cataract extraction.
- When presence of corneal edema or opacity precludes visualization or study of the anterior chamber.
- Calculating lens power for cataract patients who have undergone prior refractive surgery. Payment will only be made for the cataract codes as long as additional documentation is available in the patient record of their prior procedure. (Payment will not be made in addition to A-scan or IOLMaster.)
- Evaluating and planning treatment for patients with diseases affecting the cornea, iris, lens or other anterior segment structures.
- Providing additional information during the planning and follow-up for cornea, iris, cataract, glaucoma or other anterior segment surgeries.
- Certain exceptions that must be determined on a case-by-case basis with the appropriate documentation.
Dozens of diagnostic codes apply. Codes include, but are not limited to:
- Neoplasm: 190.0, 190.3, 190.4, 190.6, 190.8, 224.0, 224.3, 224.4, 224.6, 224.8.
- Disorders of the globe: 360.51, 360.61
- Disorders of iris and ciliary body: 364.51–364.57, 364.59, 364.60–364.64, 364.70–364.77, 364.81, 364.82, 364.89.
- Glaucoma: 365.02, 365.20–365.89
- Cataract: 366.16.
- Keratitis: 370.00–370.07.
- Corneal opacity and other disorders: 371.00–371.05, 371.20–371.24, 371.50, 371.57, 371.71–371.73.
- Disorders of conjunctiva: 372.40–372.45.
- Other disorders of the eye: 379.31–379.33, 379.39.
- Complications: 996.51, 996.53, 996.69.
OCT CODE. On Jan. 1, a new Level I code replaced a Category III code for anterior segment OCT, which is also known as scanning computerized ophthalmic diagnostic imaging (SCODI).
New code—92132 Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral.
Eliminated code—0187T SCODI, anterior segment, with interpretation and report, unilateral.